Monday 21 January 2019

A tale of three labours: Epidural, home birth and baby over 40

Sarah Carey talks candidly about her three very different experiences of giving birth to her children

Sarah Carey with David (1), James (10) and Tom (8) pictured at her home in Enfield, Co Meath
Sarah Carey with David (1), James (10) and Tom (8) pictured at her home in Enfield, Co Meath

Sarah Carey

AROUND the due date of my third and most recent baby, Teresa McCreery, one of the Community Midwives, looked at me perplexed. 'The baby's head is down and well fixed. You should be in labour. Is there anything stopping you from having this baby?" "Primal fear of death?" I offered.

It's always there. It doesn't matter who you are or where you're having your child. Mothers die. Babies die. Terrible things can happen. It's why expectant mothers go to such lengths, in vastly different ways, to feel safe.

For some that means securing the fanciest consultant or the best carpets. Others won't go near a hospital, craving the security of their own home with an independent midwife. Some sign up for an elective Caesarean on the slightest pretext because it's a controlled situation that avoids the drama of a natural delivery. Everyone is trying in their own way to protect themselves and their baby. In this decision, they are influenced by class, their mothers, friends, past experience and their personal confidence – or lack of it – in their capacity to bring a child into the world.

For my part, I was heavily influenced by my agricultural background and my mother, who was a midwife.

She had often observed that middle-class women coped badly with childbirth. Poverty is about rolling from one crisis to another, while the essence of economic wellbeing is control. But in childbirth, a middle-class woman loses control for the first time in her life. The other problem the well-heeled face is the expectation of ignorant relations that they should smile and look pretty rather than get over the shock of their profound experience.

They have just created life and contemplated death. It takes a while to recover from both the psychological and physical wounds. But whatever about the mystical effects on our psyche, the most important thing is that there's a live mother and baby at the end of the process.

So I approached my first pregnancy knowing that medical science is a miracle. Obstetricians are frequently maligned for their interfering methods, in which mothers are often unnecessarily robbed of their greatest moment – pushing their child out into the world. But mothers very rarely die in childbirth now and that's down to the drugs and the interference.

But we go to doctors when we're sick. If you and baby are healthy, there is another miracle to experience. The ancient rites of midwifery, where the calm care of an experienced midwife, who believes in your fundamental ability to give birth, guides you through the most powerful and terrifying moment of your life.

I wanted the handholding. I wanted the chance to push my babies out rather than having them pulled out. I wanted the intimacy of the relationship between mother and midwife. Deferring to the patriarchy has never been my style. But neither did I want to take any chances. How could I get the midwifery led experience but with the security of the hospital? Then someone told me about the Community Midwives in Holles Street. They would care for you throughout the pregnancy, deliver the baby either in hospital or at home, and then care for you afterwards at home too. And it was all free!

From the moment I walked through the door over 10 years ago and first met Margaret Hanahoe, the group's founder, as well as Teresa, Niamh and all the other angels of childbirth, I have felt so privileged to have them care for my family and me.

For each of the three births, the only person I ever had doubts about was myself. God it's so bloody sore and hard.

When the time came for pushing on the last one, I wept briefly because I knew what was to come.

But with a leg thrown over poor Bernie's shoulder, who assured me all was well, Kate took my hand and said so quietly and kindly, "Now Sarah, stop making noise (I had been bellowing like a cow during the mercifully quick dilation), and just push on the next contraction."

Immediately I snapped out of my self-pity and concentrated on pushing, not yelling, and I did it. Their faith in me was the only thing I needed to keep going. And that's the part that's not about science or instruments or monitors. That's the psychological bit that I can never adequately explain.

It's a question of trust. I trust them, and they trust me. And that all comes from the way they do things. So how does it work?

For babies one and three, I attended my ante-natal appointments in hospital and got to know each of the midwives. This is really important, because when labour hits and the hysterics set in, knowing the person in charge is key. I could never understand why my friends went to such trouble to secure the services of a famous doctor, who might be on holiday when they went into labour. What was the point when a stranger walked in the door to deliver?

Anyway, the midwives were always a phone call away, 24 hours a day. The clinics are run efficiently so I never waited more than 10 or 15 minutes. On baby number two, which I had at home, the midwives always visited me there. It was blissful.

They got to know my husband, Michael, too and that turned out to be vital. On my first baby, I remember heading into Holles Street on all fours in the back of the car. I had expected pain, but this was more like the force of someone taking a good run and whacking me with a bat. I wasn't so much gripped with pain, as thrown with the momentum.

I recalled watching a childbirth scene on television with my mother. As the woman screeched and roared, she had dismissively declared, "It's not like that at all; you just get on with it." I faced a choice: telly woman or stoic mother? I decided labour was the only time in my life I could make a scene and no one could give out to me. A scene it would be. That turned out to be a poor choice.

So I completely lost the head and came into Holles Street shrieking. I must've frightened the life out of my Michael, because between that and the unusually warm weather (it was November and the heating system couldn't be adjusted), the poor man duly fainted. He had to be attended to, while I, outraged at the neglect, continued to wail. A cup of tea for him and an epidural for me sorted us both out and calm descended.

Later the pushing began. It went on for over an hour. Perhaps it was the epidural. Perhaps I was too small and weak, but that baby would not come out. Someone mentioned episiotomy and I protested. I had read too much rubbish on the internet and got it into my head that being cut was a disaster. But one of the midwives said, "Sarah, the doctors are coming." We didn't want that.

So I agreed and then wondered what I had fussed about. My big baby boy was out in a couple of minutes. Afterwards I went into a kind of shock. I couldn't stop vomiting. Huge convulsions consumed me, but I was so weak I couldn't lift my head of the pillow and Niamh, who nursed me throughout, wiped it away from my face.

Every time I vomited I felt more afterbirth leak out of me. I couldn't cope with looking at the new baby being held by Michael, who began to look increasingly worried. Finally I felt myself sink and think – this can't be normal. Was I slipping away? "Am I okay?" I asked Niamh. "Yes, you are. You're going to be fine." Then added, "Just don't move."

And I believed her and didn't move, and in time, I came round. And every time I see her now, I feel like crying because I really thought something had gone wrong.

Now some people might react to this experience with a determination to avoid a repeat. But not long after I brought home that baby, I decided to get pregnant again. Being pregnant was physically hard, but I found it mentally peaceful. I'm so often worried that I'm not in the right job, wearing the right clothes or reading the right books. When I'm pregnant I know I'm doing the right thing.

You might also think that requiring the interventions I had sought to avoid might have cured me of any romantic fantasies about natural births. But I was at peace with events. The first one was always going to be the hardest, and I hadn't helped matters by losing the head.

So for the second child, I resolved to be serene, and go for the home birth. Since I lived in Blackrock, I could always ditch the plan when labour hit, and head into Holles Street for my epidural. Alas, I over-corrected. When the time came, I had so convinced myself of the necessity to stay calm, that I napped through the pre-labour and then decided the sharp pain in my bottom was a severe case of constipation.

So when my husband walked in the door, after a couple of pints with his pals, and found me sitting on the loo acknowledging I might have misdiagnosed the problem, he swung into action.

He phoned the midwives and Clodagh advised him to inspect me while she leapt into her car and sped her way to our home. But breaking land speed records would not have changed the fact that I had dallied too long, and all he could see was a head rapidly approaching.

With no drugs, the pain was unbelievable. This time I felt like my nether regions were going to explode in flames. But I could see why people discourage the epidural.

When I realised this baby was coming before a professional arrived to help, something clicked in my head and I knew exactly what to do. In between contractions, try to relax. When it came, push. Despite the drama, I actually was in control. It felt great. Sore, but great. Michael caught the baby and it was a delirious moment for both of us on which we intend to dine out on forever.

Clodagh came in then and instead of being dragged off to hospital in an ambulance, she took over. But the shock took over too, and again, my new baby was placed to one side as I retreated physically and mentally. I shivered violently. I remember my knees banging together. Clodagh tried to encourage me to get off the floor but it took a cup of tea and 20 minutes before I recovered.

But I did, and she cleaned me up and then tucked us up in bed with more tea and toast. I think that's the key difference between a doctor and a midwife. The doctor gets the baby out, but the midwife takes care of everyone, before and after. The technical term is 'seamless care'. The effect is a big bundle of love when you are most vulnerable.

For the last baby, I had moved out of the area and so was booked in for a hospital birth. In a way it's silly to have labouring mothers in cars instead of medical staff, but proximity to the hospital is important if you run into trouble.

Anyway, after that last chat with Teresa, I went home and waited. I remember sitting on the couch thinking, if we've to go this evening and my mother comes to babysit, she'll want a fire. So I cleaned out the ashes and set the fire. That did the trick and a little later my waters broke. This time we got it right.

I kept the head and adopted an air of quiet urgency. There was no shrieking and when Michael diligently stopped at orange lights, I'm sure I only inwardly cursed. And while childbirth is always a primal affair, I think I acquitted myself reasonably well. Again, I found myself post-birth quite undone. The shakes weren't as bad, but I felt overwhelmed and had a sob. It's a pity it has to be so hard.

So why do it? There's no need to seek out the drama of the farmyard when the clinical Caesarean is available. As I said at the outset, all that really matters is that there's a live mother and baby. But if you're lucky enough to have both in basic good health, don't deny yourself the opportunity to deliver yourself.

I started out with a feminist, political perspective. I wanted to be a partner in the births, not a patient subject to un-necessary procedures. But I gained more than I expected.

I've screwed up personally and professionally in my life, and many experiences can best be described as mixed.

But there is no mixed here. I did push my babies out and precisely because it's so hard, I'm really proud of myself.

And that's why I'm so grateful to the midwives. They gave me the chance to get something right. If you've got the opportunity, seize that chance for yourself and give them a call.

Sarah Carey presents 'Talking Point' on Newstalk at 1pm every Saturday

Irish Independent

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